Your Name
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First Name
Last Name
Childs Name
*
First Name
Last Name
Grade
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Pre-K
K
1st
2nd
3rd
4th
5th
6th
7th
8th
Other
Email
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Phone
(###)
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####
Select your location:
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Gig Harbor
Bainbridge
Olympia
Select your therapist
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Jason Weigold, COTA/L
Julie Kennedy, COTA/L
Amanda Diaz, COTA/L
Hailey Dow, COTA/L
Thomas Harris, COTA/L
Brittany Fox, COTA/L
Arielle Langworthy, OTR/L
Savannah Wyatt, COTA/L
Sally Carman, OTR/L
Jared Peltzman, OTR/L
Mike Peachman, OTR/L
Mel Peachman, OTR/L
Ashley Shadle, OTR/L
Elysia Smith, COTA/L
Adan Pizana, COTA/L
Aitikah Rossett, COTA/L
Erin Renard, COTA/L
Crystal Allarde, COTA/L
Emily Bryce, OTR/L
Makaylah Mitchell, COTA/L
Season Feldt, OTR/L
1. In what areas has your child shown growth and improvement?
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Please share any progress you've noticed, whether in emotional regulation, body awareness, social interactions, or other key areas.
2. Which therapy strategies or recommendations have you successfully implemented at home?
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We’d love to hear about the techniques, activities, or approaches that have been most effective in supporting your child’s progress outside of therapy.
3. Are there any ongoing challenges or new concerns you'd like to address? What areas of concern would you like to focus on next?
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Your input helps shape therapy sessions to best support your child’s needs. Let us know any current struggles and the skills you’d like to see further developed.
4. How can therapy better support you in your role as a parent?
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Whether it’s clearer milestones, additional resources, or more guidance on specific strategies, we want to ensure therapy is a valuable tool for both you and your child.
5. What other activities, therapies, or programs is your child participating in?
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Please list any sports, creative classes, or other programs your child is involved in. Understanding their full range of activities helps us support their overall development.
Thank You for Your Feedback!
We appreciate you taking the time to share your insights and updates. Your input helps us tailor therapy to best support your child's progress and ensure we’re working toward meaningful goals together.
If you have any additional thoughts or questions, feel free to reach out. We're here to support you every step of the way!
– Jason A. Weigold and the CTI Team